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While working an art therapist intern in nursing home, I observed that many of the residents seemed to have experienced a loss of empowerment. For example, one of the residents who regularly fed the fish noted that several fish had died and that we could use more. When asked if he wanted to go right now to buy some, he was startled by the question. Although the pet store was right across the street from the nursing home, he had never asked anyone to take him there. We returned from the pet store with several new fish within a half hour. Although Lidz (1983) stated that in old age, persons do experience dependency needs, it seemed that the nursing home residents had been thrust into a dependent situation abruptly and prematurely rather than having come to that stage naturally. I based this assessment on observations of affect, which included listlessness, resistance to participation in group activities at the nursing home, and resentment exhibited toward both family members and some staff members.

Kastenbaum (1979) pointed out that the process of entering a nursing home is known as institutionalization rather than individualization, making it clear that "the person must adjust more to the 'home' than the 'home' will to him" (p. 102). He explained that it is natural for an older person to react to aspects of institutionalized life as "personal onslaughts against his integrity" (p. 104) due to the removal of personal control over one's environment. The older adult must acknowledge that she or he can no longer function entirely on her or his own. But that reality does not require the older adult to relinquish his or her independence.

On the basis of the results of five studies of older adults in nursing homes, Bakes (1996) concluded that all older adults were assumed to have physical dependencies. Further dependencies, such as mental incompetence, were assumed to be attached to those physical dependencies. Of concern was the development of behavioral dependency on the part of the older adult in response to physical help given. She noted that when an older adult acted dependently, there was a social response, but when an older adult acted independently, there was no response. Older adults seeking social contact then would continue to act in a dependent manner. Thus, a condition of "learned dependency" would be created because of overcare. Baltes suggested that research is needed to identify external reasons for dependency (e.g., physical care).

There is an opportunity for professionals, particularly art therapists, who use creative methods when working with older adults in nursing homes to significantly encourage their independence. Knife (1999) summarized literature reviews that provide evidence of improved physical, mental, and emotional states when older adults are encouraged within their living environments to gain personal control of and independence within their environment.

Perhaps the most interesting finding of recent humanistic and social gerontology is that creativity remains a powerful source of growth, regardless of age. While usually associated with a visible product (a painting, poem, book, or piece of furniture, for example), creativity often results in less tangible outcomes: the altered self-image of an individual or group; a more acutely felt intuition of one's place in a family, in a religious group, or in nature.... Applied to the work of growing old, creativity--which involves affirming life and taking risks--demands continual wrestling with limits amidst changing inner and outer circumstances. (Cole & Winkler, 1994, p. 6)

One way that I promoted residents' personal control was to create personalized quilts with them in the art therapy group; the quilts were then hung next to the facility's Norman Rockwell-style pictures that were used to decorate the halls. Incorporating the residents' personal symbols of home into the quilts personalized their living space and helped them develop the sense of the nursing home space as theirs, thus giving them a sense of ownership over their new situation.

This process of developing a sense of personal control and ownership was, of course, not...

NOTE: All illustrations and photos have been removed from this article.



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